Remote food photography for the real-time measurement of children's food intake

描述（由申请人提供）：儿童和青少年超重和肥胖的患病率正在增加。令人担忧的是，超重和肥胖儿童在成年前就出现了与体重有关的健康问题，如2型糖尿病。体重增加和肥胖是正能量平衡的结果，当摄入的能量多于消耗的能量时发生，能量摄入是体重增加的重要预测因素。儿童和青少年吃的食物种类也会影响健康。儿童和青少年每天消耗500千卡以上的低营养、能量密集的食物，即使在过度消耗能量的情况下也可能发生营养缺乏。例如，肥胖儿童缺铁率较高。 需要准确的方法来测量儿童和青少年的食物摄入量，以促进研究和干预措施，促进健康饮食和体重管理。现有的方法，如自我报告（例如，食物记录），与显著参与者相关，并且与年幼儿童相关，与照顾者负担相关。此外，这些方法对食物摄入量的估计不准确（低），特别是对于体重较高的人和青少年。当使用这些方法时，一个很大的误差来源是由于参与者对份量的估计不佳。因此，有必要开发和验证方法来估计儿童的食物摄入量，即不依赖于参与者的能力，准确地估计部分大小的青少年。 我们的团队开发了远程食物摄影方法（RFPM），用于近实时测量成年人的食物摄入量，有效性数据是积极的。RFPM低估了7天内自由生活条件下的能量摄入量不到7%，与黄金标准相比，双重标记的水。当使用RFPM时，参与者使用智能手机拍摄他们的食物选择和盘子浪费的照片。这些照片立即通过无线网络发送给研究人员。参与者在智能手机上收到与生态瞬时评估（EMA）方法一致的自动提示（电子邮件），提醒他们拍摄食物照片。开发了计算机应用程序来管理EMA方法，并使用计算机成像算法自动识别食物和估计食物摄入量。快速有效地收集和分析数据，从而实现近实时的食物摄入量测量。 在拟议的研究中，RFPM将被修改，以衡量青少年的食物摄入量。然后将RFPM的有效性与笔和纸食品记录的有效性进行比较。在对RFPM进行修改并对4名青少年进行试点测试后，将在64名青少年（年龄12-18岁）的样本中测试RFPM和食物记录的可靠性和有效性。在参与者之间的平衡顺序中，RFPM将在一周内使用，食物记录将在另一周内使用。用这两种方法估计的食物摄入量将与三个黄金标准进行比较：1）在自由生活条件下通过双标记水（DLW）测量的能量摄入量，2）在学校食堂午餐期间测量的食物摄入量（能量和营养素摄入量），以及3）在实验室测试餐期间测量的食物摄入量。还将比较各种方法（RFPM和食品记录）之间的用户满意度和负担，并进行成本效益分析，以确定一种方法是否以及在何种条件下比另一种方法更具成本效益。我们还将测试RFPM的有效性是否与能量摄入水平相关。 公共卫生相关性：该项目中提出的研究将导致开发一种可靠和准确的方法来测量青少年在自然环境中生活时的食物摄入量。这种方法对公共卫生具有深远的影响。这种方法将大大推进这一人口群体的能量平衡和肥胖的研究，它可以用于大型研究，测试干预措施的有效性，以改变食物摄入量和体重。此外，该方法可以应用于临床环境，并为临床医生和患者提供了一个有价值的工具来测量能量和营养摄入。

DESCRIPTION (provided by applicant): The prevalence of overweight and obesity among children and adolescents is increasing. Alarmingly, overweight and obese children are experiencing weight-related health problems before adulthood, such as type 2 diabetes mellitus. Weight gain and obesity are the consequence of a positive energy balance, which occurs when more energy is ingested than expended, and energy intake is an important predictor of weight gain. The types of foods that children and adolescents eat also affect health. Children and adolescents consume over 500 kcal/day of low-nutrient, energy dense foods, and nutritional deficiency can occur even in the presence of overconsumption of energy. For example, obese children have higher rates of iron deficiency. Accurate methods to measure the food intake of children and adolescents are needed to facilitate research and interventions to promote healthy eating and weight management. Existing methods, such as self- report (e.g., food records), are associated with significant participant and, with younger children, caregiver burden. Moreover, these methods produce inaccurate (low) estimates of food intake, particularly for people of higher body mass and adolescents. A large source of error when using these methods is due to participants' poor estimation of portion size. Hence, there is a need to develop and validate methods to estimate the food intake of children, namely adolescents that do not rely on the participant's ability to accurately estimate portion size. Our group developed the Remote Food Photography Method (RFPM) for measuring the food intake of adults in near real-time, and the validity data are positive. The RFPM underestimated energy intake by less than 7% over 7 days in free-living conditions when compared to the gold standard, doubly labeled water. When utilizing the RFPM, participants use a Smartphone to take pictures of their food selection and plate waste. These pictures are immediately sent to the researchers via a wireless network. Participants receive automated prompts (emails) on the Smartphone that are consistent with Ecological Momentary Assessment (EMA) methodology reminding them to take pictures of their foods. Computer applications were developed to manage EMA methods and to automatically identify foods and estimate food intake using computer imaging algorithms. Data are collected and analyzed quickly and efficiently, allowing near real-time food intake measurement. During the proposed research, the RFPM will be modified to measure the food intake of adolescents. The validity of the RFPM will then be compared to the validity of pen-and-paper food records. Following modification of the RFPM and pilot testing with 4 adolescents, the reliability and validity of the RFPM and food records will then be tested in a sample of 64 adolescents (age 12-18 years). In a balanced order across participants, the RFPM will be used during one week, and food records will be used during another week. Food intake estimated with both methods will be compared to three gold standards: 1) energy intake measured by doubly labeled water (DLW) in free-living conditions, 2) food intake (energy and nutrient intake) measured during lunch in a school cafeteria, and 3) food intake measured during a laboratory-based test meal. User satisfaction and burden also will be compared between methods (RFPM and food records), and a cost- effectiveness analysis will determine if and under what conditions one method is more cost-effective than the other. We will also test if the RFPM's validity is associated with levels of energy intake. PUBLIC HEALTH RELEVANCE: The research proposed in this project will result in the development of a reliable and accurate method to measure the food intake of adolescents while they live in their natural environment in near real-time. This methodology has far reaching implications for public health. This method will significantly advance the study of energy balance and obesity in this demographic group, and it can be utilized in large studies that test the efficacy of interventions to modify food intake and body weight. Additionally, this method can be applied to clinical settings and provide a valuable tool for clinicians and patients to measure energy and nutrient intake.